730209.pdfBUILDING DEPARTMENT
PERMIT APPLICATION
t� NAME (OR NAME OF BUSINESS)
-MAILING ADDRESS
N p
, OITY
M e �S `r NAME
> ADDRESS
CITY
`d. L NAME
C&AIEK
1P
ai ai ADDRESS
CITY
/ 8 8 ATE LIOENSE NUMBER
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USE PERMIT 7'i�2.c�y
Applicant M ZONE NUMBER
Inside Heavy Linea JOB^��
ADDRESS / 9gag0 /
c9� Ip;yG
^G PERMISS LE A UA ry
IT LOT COVERAOi� LOT COVET
PERMISSIBLE HEIGHT PROPOSED HEIGHT
C^ P N]] UM(HEK ACTUAL LOT ARICA TOTAL LDO. EA
11EQUIRED YARDS PROPOSED YARDS
FAON SIDE — REAR FRONT SIDE REAR
&get Description or
Property (Snow
tlemw or
Atilt= Your Uopu
Nest 100 ft
Tract 85
Plat
of Edmonds
to an easement
GAS
RESIDENTIAL ❑ LINE
NEW
NON-RESIDENTIAL ❑ SIGN
ADD RETAINING
DEMOLISH WALL
ALTER EXCAVATE FENCE
OR FILL ^� (... ..... s_....... Ft')
PRE -MOVE
REPAIR swim
I l IN PI ` POOL
DWELLING
UNITS
LEGAL LOT VARIANCE Ott CONDITIONAL USE
❑ YES ❑ NO PERMIT NUMBER
PLANNING DEPT, APPROVAL DATE:
EXISTING STREET R/W ............FT. DEFICIENCY THIS PROPERTY
COMP, PLAN ST, R/W ............FT. ...........,FT.
REON5uw
AIA
FIRE ZONE TYPE OF
CONSTRUCTION STREET IMPROVED
i� epaxli �
I
& � W A�%�. ❑YES NO
SPECIAL INSPECTOR REQUIRED
OCCUPANCY GROUP
❑ YEB �NO
I
PLAN CHECKS BY
THIS SITE IS LOCATED IN THE CITY
OF EDMONDS. LOCAL SALES TAX
SHOULD BE CODED 31,04,
REM,�A//RK13
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L.s?iz'Li/ Fi'//. �S c-.•rv�c-,(/
Plan Check No,..„ . .....
BUILDING
PLUMBING
HEAT k OAS LINE
Valuation I Fee I Res
FENCE
SIGN
RETAINING WALL 00
N
PWIMMING POOL
DEMOLITION
PRE -MOVE INSPECTION
EXCAVATION OR FILL
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the In.
formation given to correct; and that I am the owner, or the duly author-
teed agent of the owner, I agree to Comply with city and state laws regu•
ATTENTION
lating construction; and In doing the work authorized thereby, no person
will be employed In violation of the Labor Code of the State of Washington
THIS PERMIT
relating to Workmen's Compensation Insurance,
AUTHORIZES
NOTE: Permit Limit One Year (Except DEMOLITIONS which
ONLY Tim
WORE NOTED
shall be completed In ninety days; MOVED -IN BUILDINGS shall be oom•
pleted In six months.)
31ONATURE (OWNER OR AGENT) DATE 010NED
INSPECTION
d 73
DEPARTMENT
2
CITY OF
EDMONDS
NOTE: Applicant Subject to Plan Check Fee
PR M1107
This Permit coven work to be done on private property ONLY,
Any construction on the pubUc domain (curbs, s"•walks, driveways,
ma"uees, site) will nOmn separate( .issime
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APPLICATION APPROVAL
This Application is not a permit until
signed by the Bullding Official or his Dep-
i
uty; and fees are paid, and receipt is Rem
Imowledged In space provided.
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